One of the biggest challenges in caring for patients with Rheumatoid Arthritis (RA) and Juvenile Rheumatoid Arthritis (JRA) is quantifying the degree of disease activity in any given joint. It can even be difficult to determine whether inflammation is present or absent. Carefully designed studies have repeatedly shown poor We have built a prototype device using well-established sensors-specifically 3-dimensional (3D) laser line triangulation digitizer cameras and thermal infrared cameras-to rapidly quantify surface swelling and heat in arthritic joints. This Arthritis Surface Imager produces results within minutes. Thus it could become a routine component of the rheumatology clinic visit, allowing for the replacement of the current subjective and unreliable joint assessment with a quantitative and highly-reproducible measure that can be used to monitor patients over time. The goal of our studies is to test the hypothesis that this Imager can improve the clinical assessment of arthritis. The first Specific Aim is to test the hypothesis that surface imaging will provide an earlier and more sensitive measure of change in active arthritis and functional status than do physician's assessment and patient's self-assessment A cohort of patients with JRA and RA will be followed longitudinally before and during the course of a therapeutic intervention. Change in arthritis, as measured by the Arthritis Surface Imager will be compared to well-established and validated clinical measures, including 1) physician's assessment of joint tenderness and swelling and 2) patient's self-assessment of joint pain. Correlation will also be made with changes in functional status, as assessed by components of the Childhood Health Assessment Questionnaire (CHAQ) and Health Assessment Questionnaire (HAQ) that pertain to hand function. We will also examine predictors of change in functional status. The second Specific Aim will test the hypothesis that surface imaging can improve the accuracy of remission measurement. It has recently been reported that patients in clinical remission often have MRI evidence of continued synovitis, demonstrating that current clinical measures of inactivity do not correlate well with true remission. Our Preliminary Studies suggest that many patients with a history of arthritis have abnormal joint thermal patterns even when asymptomatic. Patients with clinically-inactive disease will be imaged by MRI to determine whether patients with subclinical arthritis can be identified by the Arthritis Surface Imager. Low-cost, time-efficient tools that produce a set of reliable, reproducible and objective measures of the inflammatory state of the joint would improve the assessment of outcome in arthritis clinical studies, and ultimately will improve patient care. This proposal focuses on the wrist and metacarpophalangeal (MCP) joints, which make up 22 of the 28 joints in the Disease Activity Score (DAS) 28. Methodologies developed here could be readily applied to other peripheral joints. reproducibility of physician assessment of the number of swollen and/or tender joints. PUBLIC HEALTH RELEVANCE: One of the biggest challenges in caring for patients with Rheumatoid Arthritis (RA) and Juvenile Rheumatoid Arthritis (JRA) is quantifying the degree of disease activity in any given joint. We have built a prototype device using well-established sensors to rapidly quantify surface swelling and heat in arthritic joints. The goal of our studies is to test the hypothesis that this Imager can improve the clinical assessment of arthritis.